As pelvic rehabilitation therapists, our role has traditionally focused on restoring continence, alleviating pain, and improving quality of life. Yet within athletic populations, pelvic floor dysfunction often presents in unique and nuanced ways—masked by high levels of conditioning, normalized symptoms, or misattributed pain patterns. As the bridge between performance and pelvic health, we are uniquely positioned to address these challenges.

In athletes, the pelvic floor must do more than support visceral structures or maintain continence. It plays an integral role in force transmission, lumbopelvic stability, breathing mechanics, and reflexive motor control. The demands of sport—sprinting, lifting, jumping, cutting—place high, repetitive loads on the core system, often revealing (or creating) dysfunctions in timing, tone, and coordination of the pelvic floor.

The athletic population requires a different lens: one that views the pelvic floor as a functional component of the kinetic chain and not in isolation.

Clinical Presentations: What We Commonly See

• Stress Urinary Incontinence (SUI) in High-Impact Sports: Female athletes, particularly in gymnastics, track, CrossFit, and volleyball, often experience SUI—yet many have strong pelvic floor muscles on MMT. The issue is frequently one of timing, coordination, or excessive tension rather than weakness. Screening for functional incontinence during movement (e.g., jumping or heavy lifting) is essential.
• Hypertonicity and Myofascial Pain: High-performing athletes often exhibit pelvic floor overactivity—either from compensatory stabilization or stress-related holding patterns. These individuals may present with deep hip pain, dyspareunia, tailbone pain, or abdominal discomfort. Common coexisting findings include labral pathology, SIJ dysfunction, and overuse injuries.
• Core Dysfunction and Lumbopelvic Instability: Poor load transfer across the pelvis, impaired breath mechanics, and delayed transversus or multifidus activation often coexist with pelvic floor dyscoordination. This population may present with chronic low back pain, hip impingement, or even sports hernia.
• Postpartum Athletes: Returning to sport postpartum brings unique challenges—diastasis recti, levator avulsion, prolapse, and deconditioning of core synergy. Pressure to return to performance prematurely can exacerbate dysfunction if pelvic rehabilitation is bypassed.

Assessment Considerations for the Athletic Client
In working with athletes, it’s critical to think beyond isolated internal examination and assess whole-system function:

• Breath and Pressure Management: Assess how the client regulates intra-abdominal pressure during dynamic tasks (e.g., lifting, landing, change of direction).
• Pelvic Floor Mobility and Control: Use internal and external assessments to evaluate both overactivity and under-recruitment, including timing during functional movement.
• Core Integration: Test synergistic recruitment of diaphragm, transversus abdominis, multifidus, and pelvic floor during anticipatory and reactive tasks.
• Functional Movement Screens: Incorporate squat mechanics, running gait analysis, lunge variations, and single-leg stability to evaluate force transfer and pelvic control under load.
• Load Testing: Progress assessments to mimic sport-specific demands—e.g., jumping with pelvic floor biofeedback, agility drills with breath cueing.

Treatment Priorities in Pelvic Rehab for Athletes

• Down-Training Before Strengthening: Many athletic clients do not need Kegels—they need to let go. Releasing hypertonic tissues, restoring breath, and retraining pelvic floor length-tension balance is often the starting point. Re-establishing proper sequencing of breath, pelvic floor, and deep core muscles is essential. Use dynamic cuing, load modulation, and real-time feedback (e.g., pressure biofeedback, US imaging) to reinforce neuromotor control.
• Myofascial and Manual Therapy: Trigger point release (levator ani, obturator internus), neural mobilization (pudendal nerve, obturator nerve), and SIJ or hip mobilizations are often necessary for full pelvic system mobility.
• Functional Reintegration: Rehabilitate pelvic floor activation in context—squatting, lifting, running, jumping. Train coordination across planes of motion, not just in supine or side-lying.
• Athlete-Specific Return-to-Play Criteria: Use objective metrics—continence during max effort, pelvic floor coordination under fatigue, breath control under load—to clear clients for return to sport. Consider incorporating pelvic floor testing into movement screens or performance evaluations.

Our Expanding Role
As pelvic rehab therapists, we are more than continence specialists—we are movement specialists. Within sports medicine, we bring a unique capacity to identify root causes of dysfunction that go unseen by traditional orthopedic approaches. Our collaboration with strength coaches, orthopedic PTs, sports MDs, and athletic trainers is critical in shaping a comprehensive, athlete-centered plan.

Pelvic rehabilitation is a performance tool. In the athletic population, our interventions can prevent injuries, improve performance, and support longevity in sport. By approaching the pelvic floor as a dynamic contributor to the kinetic chain, we can elevate the standard of care and advance our profession’s impact in sports medicine.

The Course Options
Athletes and Pelvic Rehabilitation remote course scheduled for July 26-27. In this course, Dr. Dischiavi covers evidence-based, immediately-applicable skills related to pelvic floor rehabilitation for the athlete, including treatment philosophies for the pelvis and pelvic floor, and global considerations of how these structures contribute to human movement. Topics include urinary incontinence, as well as the intricacies of athletic movement and how energy transference throughout the kinetic chain is crucial to the rehabilitation approach, injury prevention, and high performance. This course will also cover biomechanics behind human movement of the lumbopelvic-hip complex, so the participant will be able to prescribe effective and innovative therapeutic exercise programs. The connection of how pelvic rehab influences LE pathologies such as ACL, PFP, and chronic ankle instability will be covered. Although this class has a focus on athletes, these concepts of biomechanics and movement patterning are applicable to all patients in the clinic.

The Runner and Pelvic Health is a one-day, remote course scheduled for July 26, created and instructed by Aparna Rajagopal PT, MHS, WCS, PRPC, and Leeann Taptich DPT, SCS, MTC, CSCS. This course is designed to expand your knowledge of the pelvic floor in running athletes. Through lecture and labs by video and participation, participants will learn what normal and abnormal running mechanics are and how the muscles work simultaneously during running. This course includes advanced assessments to help diagnose the reason for movement dysfunction. All assessments can be easily integrated into a therapist's evaluation skill set. The course is applicable for patients who present with pelvic pain, incontinence, constipation, prolapse, postpartum, and lumbar pain.